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UO/UJ/ LUU1 1U.L1 --1- <br /> EHL)LOG NUMB <br /> DATE RECEIVED SAN JOAQUIN COUNTY %"GOOF, <br /> (� ���(��� ` Is I(�I ENVIRONMENTAL HEALTH DEPARTMENT <br /> t1\�I lav 304 E Weber Ave 3'd Floor Stockton.,CA 95205 - <br /> JUN 0 3 Zff)468-3420 Fax: (209) 464-01.38 Web:www.co.san joaquin.ca.ug/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESWAGENCY: n <br /> ADDRESS: <br /> PHONE: Ot D 7 —FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: J� Jud 4 Time: <br /> (please allow 10 business days from!late of application submittal] <br /> /A an yam No •.. . <br /> CHECK BOX TO EXPEDITE REQUES -$g .00 FEE–REQUEST ROC ED IN 3 BUSINESS DAYSj�� <br /> DATE <br /> SIGNATURE OF APPLICANT y <br /> arhnent use OMv <br /> FILE ADDRESS UNIT <br /> c e2�1 D �?0 L [] Unit 1 <br /> 3. stm6t b0l Cky unit 2 �cJ <br /> \ <br /> 1. <br /> mat D $ u ✓ <br /> _ Unit 3 <br /> v a! C1 <br /> 6. Shaet ' <br /> _ A a C � Unit <br /> _ Pe - cry ° <br /> 8. StrnM ' <br /> a. suppt /Q_ ��� ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> }l7A .: r— <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT ❑ SOLID WASTE ACILiT` L <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REmOVAL) ❑ DOG KENNEL C3 DAIRY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTI;LIHOTEL 17 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOo/eDDY PIERCING ❑ POOLISPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD'files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of appl(cation. The files <br /> Will be held for a maximum of five business days for review. Appointment$should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff At the expense <br /> of the applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 6. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business da sm <br /> CONFIRMED APPOINTMENT DATE _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 44-N-ON <br />